Miyopatide Katılım Paterni Elektrofizyopatolojisinin Elektrofizyolojik Yöntemlerle İncelenmesi
Özet
In myopathies, there is no detailed examination of the early
recruitment patterns mechanism observed in needle EMG, which is observed as
the "firing of multiple motor units during minimal contraction". One of the
possible mechanisms is the change in cortical or spinal excitability. In this study,
the role of central excitability changes in the early recruitment of myopathy was
investigated. In the study, cortical or spinal level excitability was examined using
cutaneous silent period, H Reflex and transcranial magnetic stimulation studies
in 12 patients and 27 healthy controls. During double stimulus tests in myopathy
patients compared to normal subjects, the change in normal physiological
facilitation or inhibition observed in the H reflex or motor-evoked potential
(MEP) response after conditioned stimuli is thought to reflect a change in the
cortical or spinal level excitability. The most important finding of the study was
that, at the end of KuSS using spinal inhibitor circuits, inhibition of MEP observed
in normal subjects was not observed in myopathic patients, on the contrary MEP
facilitation was observed. This finding is consistent with disinhibition at the
spinal level, suggesting that early recruitment phenomena may be due to
changes in the excitability at the spinal level without alteration in the central
drive effect. Again observation of no significant difference between the control
and the patient group in double stimulation studies performed with resting
motor threshold and cortical silent duration suggests that there is no significant
change in excitability at cortical level in myopathy patients. With obtained
findings, interpretation of the physiopathology of the early recruitment pattern
is thought to provide an understanding of the strategy of increasing the force in
myopathies and to shed light on symptomatic treatment approaches of this
group of patients and on the different physiopathological processes that use
similar mechanisms.